Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis

Werge, Mikkel; Novovic, Srdan; Schmidt, Palle Nordblad; Gluud, Lise Lotte

doi:10.1016/j.pan.2016.07.004

Cited by 174 publications

(125 citation statements)

References 75 publications

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“…8 According to a recent systematic review, mortality doubles when (peri) pancreatic necrosis becomes infected in patients with coexisting organ failure. 44 Reducing infected necrosis, morbidity, and mortality is the rationale for administering prophylactic antibiotics (before a documented infection) to patients with either predicted SAP (which is associated with a higher risk of developing necrotizing pancreatitis) or those with established necrotizing pancreatitis. The antibiotics used in most of the AP trials were capable of penetrating the infected necrosis, for example, fluoroquinolones, metronidazole, carbapenems, and third-generation cephalosporins.…”

Section: Question 2: What Is the Role Of Prophylactic Antibiotics In mentioning

confidence: 99%

Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review

et al. 2018

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Section: Question 2: What Is the Role Of Prophylactic Antibiotics In mentioning

confidence: 99%

Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review

et al. 2018

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“…In primary bacterial cultures from foci of infected necrosis, fungi are identified in 6-46% of patients with AP [3,51,[66][67][68][69][70]. This unusually wide range of the results is due to the different assessments (either per the entire reviews population of patients with AP, or among patients with necrotic pancreatitis, or those with severe AP).…”

Section: Antifungal Prophylaxis For Acute Pancreatitismentioning

confidence: 99%

“…Infection is a life-threatening factor in patients with acute pancreatitis (AP), as evidenced by significantly higher mortality rates in this category of patients as compared with those with sterile necrosis [1][2][3][4][5][6]. The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well.…”

Section: Introductionmentioning

confidence: 99%

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

Firsova¹,

Паршиков

Кукош

et al. 2020

Sovrem Tehnol Med

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Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

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“…Mortality in patients with infected pancreatic necrosis and organ failure is approximately double that found in patients with sterile pancreatic necrosis and organ failure. 29 The microbial composition of infected pancreatic necrosis was previously dominated by gram-negative flora of GI origin, such as Enterobacteriaceae . However, in the recent years, the widespread use of prophylactic antibiotics have shifted the dominant flora to Staphylococcus, Enterococcus and Candida .…”

Section: Introductionmentioning

confidence: 99%

The Gut Microbiome in Pancreatic Disease

Akshintala¹,

Talukdar

Singh³

et al. 2019

Clinical Gastroenterology and Hepatology

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The gut microbiome is increasingly recognized for its role in human health and disease. Initial evidence indicates that gut microbial dysbiosis is associated with several pancreatic diseases. Although it is not known if these associations are causative, gut dysbiosis is hypothesized to mediate chronic pro-inflammatory changes in the pancreas. Further mechanistic and epidemiological studies of the microbiome are needed. Ultimately, targeted modulation of the microbiota could have therapeutic value.

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Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis

Cited by 174 publications

References 75 publications

Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review

Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

The Gut Microbiome in Pancreatic Disease

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